Queen Elizabeth II Academy
for Leadership in International Affairs
Academy Asfari Fellowship Application Form
SUMMARY
First Name
Surname/Family name
Other names/patronymic
Date of birth
Gender
Male
Work Address
Street:
City:
Region:
Postal Code:
Country:
Telephone:
Email:
Home Address
Street:
City:
Region:
Postal Code:
Country:
Telephone:
Email:
Female
Prefer not to say
Please provide your preferred email address:
Please provide your Skype address:
Select your nationality:
Iraqi
Jordanian
Lebanese
Select your fellowship:
Academy Fellow (12 months duration)
Palestinian
Syrian
Academy Senior Fellow (6 months duration)
Select your preferred start date (Senior Fellowships only):
September 2016
February 2017
Please tick which research topic you would want to work on during your Academy fellowship:
Law and war: promoting respect and improving
The delivery of humanitarian aid in areas occupied
compliance
by non-state armed groups
Internet governance in the Middle East
Cultural property protection and its role in conflict
Youth participation in Palestine
Reconstruction and state-building in Iraq
Proposed Research Title
Instructions for submission
Please email this form, along with your Writing Sample (10 A4 pages only), to
AsfariFellowships@chathamhouse.org
Applications must be received no later than 31 May 2016. Late or incomplete submissions will not be considered.
This Academy Fellowship is made possible through the generous support of the
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1. LEADERSHIP EXPERIENCE
Please describe an instance where you have shown leadership.
Please write your word count here:
(Maximum 300 words)
What do you believe are the chief opportunities and challenges facing leaders today?
What are the most important attributes of a leader?
Please write your word count here:
(Maximum 300 words)
Why do you want to pursue a fellowship at the Queen Elizabeth II Academy?
What, in particular, makes this different for you from other fellowships?
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Please write your word count here:
(Maximum 250 words)
How will the fellowship and the Academy’s Leadership Programme benefit you, and what do you
want from it?
Please write your word count here:
(Maximum 100 words)
Why should you be chosen for this fellowship and what leadership experience will you bring to the
Academy?
Please write your word count here:
(Maximum 100 words)
What impact do you want to have in your region and/or field, and how will your research help?
Please write your word count here:
(Maximum 100 words)
What do you plan to do following your fellowship, and how will you apply your learning?
Please write your word count here:
(Maximum 100 words)
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2. RESEARCH PROPOSAL
Proposed Research Title
Please list the one or more main research question(s) or hypotheses you intend to explore with
your research:
1.
2.
3.
Please write your word count here:
(Maximum 100 words)
Please provide a summary of your research proposal.
This should outline the topic to be investigated and any activities you might plan (e.g. fieldwork,
research roundtable)
Please write your word count here:
(Maximum 350 words)
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Please outline your proposed research methodology:
Please write your word count here:
(Maximum 100 words)
Please outline your timeline of research activities
Month 1:
Month 2:
Month 3:
Month 4:
Month 5:
Month 6:
Month 7:
Month 8:
Month 9:
Month 10:
Month 11:
Month 12:
Please write your word count here:
(NB: Senior Fellows complete Months 1-6 only)
(Maximum 150 words)
Please state the known risks which could affect your research and how you would mitigate these.
Please write your word count here:
(Maximum 100 words)
Why do you believe your research to be important? What impact will it have?
Please write your word count here:
(Maximum 100 words)
What do you believe to be the relevance to the policy community of your research?
Please write your word count here:
(Maximum 100 words)
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3. Curriculum Vitae (Two pages only)
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3. Curriculum Vitae (Two pages only)
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4. Referees
Please provide the contact details of two referees (at least one being academic):
Name:
Name:
Job title:
Job title:
Employer:
Employer:
Work Address
Work Address
Street:
Street:
City:
City:
Region:
Region:
Postal Code:
Postal Code:
Country:
Country:
Telephone:
Telephone:
Email:
Email:
Skype:
Skype:
Relationship to you:
Relationship to you:
Note: We may contact your referees if you are shortlisted for interview
5. Personal Commitments
Fellows must be based at Chatham House in London for the full duration of the fellowship and are
expected to work full-time towards their fellowship.
Given this, will you need to leave the United Kingdom regularly during the fellowship for
employment or family reasons?
No
Yes
If yes, please provide details:
Chatham House cannot sponsor visas or provide any logistical support for a fellow’s dependants.
Given this, do you intend to be accompanied by any family members or dependents?
No
Yes
If yes, please provide details of their immigration status and how they will be supported financially during their
stay:
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6. Where did you hear about the fellowship?
Chatham House website
Chatham House email or newsletter
If possible, please specify which newsletter:
Chatham House
Queen Elizabeth II Academy
Other
Word of mouth (e.g. friend/colleague)
If possible, please specify: ____________________________________________
Social media (Facebook/Twitter/LinkedIn etc.)
If possible, please specify: ____________________________________________
Other
If possible, please specify: ____________________________________________
7. Checklist
Please tick the boxes below to confirm you have:
Inserted a 2-page copy of your Curriculum Vitae into this Application Form
Signed and dated this Application Form
Included in your submission a separate Writing Sample (Maximum 10 A4 pages only)
8. Declaration of Consent
Please tick the box below if you would like to receive future Academy communications, such as
notifications of future fellowship opportunities or updates on the Academy’s activities:
I hereby declare that the above statements are correct and complete. Chatham House has my permission to process,
evaluate and store my personal information. Upon my acceptance to the fellowship programme, my personal data
and photograph may be used in Academy publications and on the Chatham House website.
Signature:
Date:
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